Endoscopic Diagnose And Treatment Of Early Colorectal Tumor

Part 1 Risk factors analysis and prediction model construction of submucosal deep infiltration of early colorectal tumorBackground Accurate diagnose of the infiltration depth of early colorectal tumor(ECT)can help doctors make decisions on the most appropriate treatment for the patients before operation.Although there are many endoscopic techniques that can help to judge the depth of infiltration of ECT,the sensitivity,specificity or accuracy of single factor index judgment are often not very high,and there is great subjectivity.Therefore,the aim of this study is to explore the risk factors of deep infiltration and try to construct a prediction model to judge the depth of infiltration of ECT.Methods This study retrospectively analyzed the clinical and pathological data of ECT patients undergoing endoscopic treatment or radical surgery in the Cancer Institute and Hospital,Chinese Academy of Medical Sciences(CICAMS)from August 2010 to December 2020.The independent risk factors of deep infiltration of ECT were determined by multivariate Logistics regression analysis.Finally,the included independent risk factors were constructed and verified by Nomogram.Results In this study,717 patients with ECT were included for modeling and analysis.A total of 590 patients were divided into Within SM1 Group(infiltration depth within SM1)and 127 patients were divided into Exceeding SM1 Group(infiltration depth exceeding SM1).There was no significant difference in gender,age and lesion location between the two groups.Multivariate logistics regression analysis showed that only erosion or rupture(OR=4.028,p=0.007),local depression(OR=3.105,p=0.001),invasive JNET classification(OR=5.622,p<0.001)and invasive pit pattern(OR=2.722,p=0.006)were independent risk factors for deep submucosal infiltration in ECT.The Nomogram was constructed from the independent risk factors and applied to clinical practice.A total of 114 cases were included as the validation group.Through the validation of the model in the modeling group and the validation group,the results show that the model had good discrimination and calibration in predicting deep submucosal infiltration in ECT.Conclusions In this study,the Nomogram prediction model based on multivariate logistic regression model of various endoscopic manifestations of ECT had good prediction efficiency in the of deep submucosal infiltration in ECT.Part 2 Safety and efficacy of endoscopic submucosal dissection for metachronous early cancer or precancerous lesionsemerging at anastomotic sites after colorectal cancer surgery Background The incidence of metachronous early cancer or precancerous lesions(MECPL)emerging at the anastomotic site(AS)after curative surgical resection of colorectal cancer(CRC)is so low that few study have been conducted to explore the clinical characteristics,diagnosis and treatment of these lesions.Endoscopic submucosal dissection(ESD)is technically difficult for these lesions because of the presence of severe fibrosis and AS.The aim of this study was to explore the safety and efficacy of ESD for MECPL emerging at the AS after curative surgical resection of CRC.Methods The data used in the analysis were retrospectively collected from CICAMS in Beijing China between January 2014 and May 2019 and from all the patients who underwent ESD for MECPL emerging at the AS after curative surgical resection of CRC.The en bloc resection rate(ER),complete resection rate(CR),curative resection(CuR)and the rate of incidence of complications were analyzed by SPSS software.Results A total of 11 patients who underwent ESD for MECPL emerging at the AS were included.The median operative time was 48 minutes(Min-max:40-262 minutes).The ER,CR and CuR were 63.6%,54.5%and 54.5%,respectively.Bleeding occurred in only one case and there was no perforation after the operation.No additional surgery was performed,and in the median follow-up time of 14 months,no recurrence,lymph node metastasis and distant metastasis were found.Conclusions Overall,ESD is safe and effective in the treatment of MECPL emerging at the AS after curative surgical resection of CRC.Especially for patients with anastomotic recurrence close to anal margin,this method can avoid the risks of reoperation and improve the rate of anal preservation.